Self-reported hypertension treatment beliefs and practices of primary care physicians in a managed care organization

Margolis, Karen L.; Rolnick, Sharon J.; Fortman, Kristine K.; Maciosek, Michael V.; Hildebrant, Carrie L.; Grimm, Richard H.

doi:10.1016/j.amjhyper.2004.10.030

Cited by 22 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, a prior study found that the majority (55%) of a sample of primary care physicians surveyed in 1999 believed that BP could usually be controlled using only 1 antihypertensive medication. 13 Comparatively, our study's findings could imply that increased physician knowledge of hypertension management may have been affected by the widespread dissemination of JNC-7, which includes strong support for the use of 2 or more antihypertensive medications in most patients.…”

Section: Discussionmentioning

confidence: 80%

Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives

et al. 2008

View full text Add to dashboard Cite

The role of clinical inertia in the treatment of patients with hypertension was assessed by evaluating health care providers' knowledge, attitudes, and clinical practices regarding hypertension management. A cross-sectional survey was conducted at the Forsyth Medical Group in North Carolina. Participants were physicians (N = 18, 10 sites) and support staff (N = 20, 12 sites), who were surveyed in 2006. Physician and support staff questionnaires consisted of 29 and 15 items, respectively, and were administered by trained interviewers. Though most physicians (94%) cited familiarity with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines and affirmed that hypertension management guidelines are relevant to their patients, no physicians interviewed routinely document patient hypertension management plans. Although 1 in 3 physicians cited the inability to devote enough time to patients for the discussion of hypertension management, physicians predominantly cited patient- and support-staff- related factors as most important to patients not attaining blood pressure (BP) goal. Patient lifestyle modification (89%), education (67%), and medication compliance (56%) were cited as the most important reasons for uncontrolled BP. Only one-third of physicians believe that clinical staff always obtain accurate BP measurements, and 61% believe that resistant hypertension is a reflection of inaccurate BP measurement. Many support staff claimed to be rushed when measuring patient BP, and 65% recommended BP competency training. Contradictions were evident between provider knowledge of hypertension management standards and how this knowledge is applied in clinical practice. Standardized collection of BP is critical to measuring clinical improvement in hypertension. Results are being utilized to develop clinical improvement initiatives including staff education and competency training.

show abstract

Section: Discussionmentioning

confidence: 80%

Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives

et al. 2008

View full text Add to dashboard Cite

show abstract

“…In our study, the Cockcroft-Gault formula was used instead of the Modification of Diet in Renal Disease formula when evaluating renal func tion because French laboratories do not use the Modification of Diet in Renal Disease formula and because ethnicity (mandatory in the Modification of Diet in Renal Disease formula) was not recorded. 21 BP as a CV risk factor is well understood by physi cians as already reported by Margolis et al 22 in the analysis of selfreported practices in 104 American primary care physicians. However, other individual risk factors such as diabetes, renal failure, and cardiac damage are not taken into account by GPs to set a BP target.…”

Section: Resultsmentioning

confidence: 68%

“…[5][6][7]23 At the end of the visit, drug therapy increment was modest (0.4 drug) confirm ing the fact that physicians are reluctant to prescribe multiple drug therapy. 15,22,[24][25][26] Although diuretic monotherapy was not often used (16.9%), practitioners knew it was important to include diuretics with multipledrug therapies. A diuretic was associated in 75% of dual therapy and 91% of triple therapy.…”

Section: Resultsmentioning

confidence: 99%

Major Cardiovascular Risk Factors Are Not Taken Into Account by Physicians When Targeting Blood Pressure Values for Uncontrolled Hypertensive Patients

Ducher

Juillard

Leutenegger

et al. 2008

American Journal of Hypertension

View full text Add to dashboard Cite

A linear relationship exists between the logarithm of cardio vascular (CV) complications and blood pressure (BP) levels. 1 According to the European and American regulatory authori ties, 2-4 the aim of hypertensive treatment is to reduce BP values to <140/90 mm Hg in all hypertensive subjects. In diabetic and renal patients who are at higher CV risk, the recommended BP goal is even lower. Failure to normalize BP values reduces the patient's life expectancy. In clinical research, a planned drug increment will enable 70% of patients to reach recom mended systolic BP (SBP) goals. [5][6][7] In daily practice, although the control of hypertension has increased threefold over the past 20 years, 8 it still remains markedly insufficient. In fact, observational studies show that only 20-30% of patients reach their BP target. [9][10][11] There is a gap between the proved efficacy of available drugs in clinical trials and the low percentage of patients with normalized BP in daily practice. Until now, the main factors studied possibly explaining inadequate BP con trol in the population have been related either to treatment (efficacy, drug combinations) or to patients (compliance, social coverage, income). 12-14 The "physician" factor has not yet been studied thoroughly enough. The physicianrelated factor could explain the discrepancy between treatment efficacy in trials and in daily practice. For instance, Okonofua et al. 15 reported a physicianrelated therapeutic inertia to increase or modify drug therapy even when BP was not normalized. Ferrari et al. 16 reported that delayed drug effect and the fact that a BP goal was almost reached (office or selfmeasured BP) could explain therapeutic inertia. To further analyze the "physician factor, " we checked the consistency between SBP targets set by physi cians and the guidelines depending on patients' individual risk factors and on the Framingham coronary heart disease (CHD) risk score. 17 MethodsIn this crosssectional study, investigators were selected accord ing to medical demographics in metropolitan France. A total of 1,031 general practitioners were invited to participate. Among BackgroundThe main factors studied possibly explaining inadequate blood pressure (BP) control in the population are related either to treatment or to patients. Subjective behavior of physicians might also explain insufficient BP control in the population. This study analyzed the consistency between systolic BP (SBP) targets set by physicians for uncontrolled hypertensive patients and the guidelines according to cardiovascular (CV) risk factors.

show abstract

“…Contrary to the high diabetes prevalence among PLHIV [100], some studies reported a lower prevalence among the HIV positive population compared to HIV negative population. These controversies warrant more studies to be undertaken [101].…”

Section: Diabetes Mellitus and Artmentioning

confidence: 99%

The Effect of HIV and Art on the Development of Hypertension and Type 2 Diabetes Mellitus

Maseko¹,

Masuku²

2017

J Diabetes Metab

View full text Add to dashboard Cite

Diabetes mellitus and hypertension [DM] are among the major causes of morbidity and mortality among people living with human immunodeficiency virus [PLHIV]. Diabetes mellitus alone is associated with morbidities that consequently reduce life expectancy and quality of life, and causes demoralising complications inclusive of ischaemic heart disease, stroke, blindness and peripheral vascular disease. Hypertension is an important and treatable cause of cardiovascular morbidity and mortality. It is an independent risk factor for myocardial infarction, chronic kidney disease ischemic and haemorrhagic stroke, heart failure and premature death. HIV infection is associated with morbidities that consequently reduce life expectancy and quality of life. There is a perceived link between HIV infection and DM and hypertension. This is a scoop review of studies on the link between HIV and DM and hypertension, that is, both epidemiologic and biological evidence to date. The literature review shows that the incidence and prevalence of type 2 diabetes [T2DM] is higher among PLHIV on ART compared to the HIV negative population. Being infected by human immunodeficiency virus (HIV) is implied to trigger an inflammatory response that, in turn, results in insulin resistance, a risk for T2DM. HIV is linked to hypertension through alterations in triglycerides, T cells and angiotensin II as well as the aggressive use of ART. The roll out of antiretroviral therapy (ART), as means to combat HIV, has benefits for PLHIV, inclusive of increased survival and living longer; yet older age is associated with hypertension and T2DM. The side effects of ART and long term use of ART are implicated in increasing the risk of T2DM among PLHIV. The co-occurrence of HIV, hypertension and T2DM in developing countries presents an overload to the burden of diseases because these countries are already experiencing high prevalence rates of HIV thereby complicating the health status of the population. Notwithstanding the contrasting research reports on the link between HIV, hypertension and DM hypertension and DM among PLHIV is a cause for concern, and there is a need for more studies, particularly in areas most hit by HIV.

show abstract

Self-reported hypertension treatment beliefs and practices of primary care physicians in a managed care organization

Cited by 22 publications

References 31 publications

Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives

Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives

Major Cardiovascular Risk Factors Are Not Taken Into Account by Physicians When Targeting Blood Pressure Values for Uncontrolled Hypertensive Patients

The Effect of HIV and Art on the Development of Hypertension and Type 2 Diabetes Mellitus

Contact Info

Product

Resources

About